From Pilot to Process – Implementing Blockchain into the

Episode and Economics of Care - Part 1

Session 4, Blockchain Symposium

• Jim St.Clair, CTO, The Dinocrates Group LLC (Moderator)

• Robert Miller, CEO, Honeycomb Health

• Rishi Madhok, MD, Chief Executive Officer, BitMED

• James Zadoorian, PhD, Managing Principal, ArxChange

Organization logo(s) may be placed on this slide

Neither the Moderator nor panelists have real or apparent conflicts

of interest to report.

Conflict of Interest

Robert Miller, BA

Salary: Consultant for non-profit Greater Good

Consulting Fees (e.g., advisory boards):

PhUSE Blockchain in Healthcare Working Group

IEEE Blockchain in Healthcare Standards Development Working

Group

Blockchain in Healthcare Global Member

Ownership Interest (stocks, stock options or other ownership

interest excluding diversified mutual funds): Own stock in

Honeycomb Health and RemediChain. Also a board member of

RemediChain.

Other: I also own BTC and ETH.

Conflict of Interest

• While there is no shortage of blockchain use cases for healthcare,

working applications, pilots and deployments are still hard to find.

This session look past whitepapers to projects that are actively

being piloted or deployed - real word use cases.

• To truly fulfill the idea of blockchain as a force for change, we

need to see solutions that could not have exist in a world without

it.

• This session will give the stage to companies who have embraced

this new technology and are using it to change a broken system.

Agenda

• Outline a systemic healthcare problem and present a new solution

• Discuss why blockchain is core to the solution

• Provide an overview of a future state and how things will be

different with widespread adoption

• Outline some of the design/platform decisions made and

challenges overcome

Learning Objectives

Robert Miller, CEO & Co-Founder, Honeycomb Health

What are tokens?

Tokens are digital assets created on top of a

blockchain. These take two primary forms:

Currencies

Digital goods

Non-unique, currency-like digital assets that are

interchangeable.

Most “Healthcare tokens” or “healthcare

cryptocurrencies” are ERC20 tokens.

Different models for how these are used. Most common

overall and within healthcare is the payment token, a

currency used only to pay for goods or services within a

closed ecosystem.

Currency tokens (“Fungible”)

Digital goods tokens

(“Non-Fungible” or NFTs)

Technical standard: ERC721

Unique, one of a kind digital

assets with attributes. These are

not interchangeable.

First use cases were for trading

card like games.

Anatomy of a NFT

DNA / Attributes

Category 1: 2

Category 2: 128

Category 3: 8

Category 4: 92

Owner: 0xf7Ac9D59…

Anatomy of a NFT - healthcare

Attributes

good_id: 0x121f..

batch: 0x0fnw2…

dispatch: 1293…

prod: 0x321zq…

quantity: 128

Last_owner: Manufacturer

Owner: Supplier

Anatomy of a NFT - healthcare

Attributes

Issued by: NYU

Degree: Doctor of Medicine

Practice: NY

Date: 1/16/2019

Signed by: 0x1y8i100….

Owner: Physician

Currency tokens were the first

wave of healthcare tokenization

• ~200 attempted healthcare tokens from 2016 -

2018.

• ~$500,000,000 dollars were raised through

Initial Coin Offerings (ICOs)!

• Data suggests that almost all healthcare tokens

are built on Ethereum

… but these didn’t turn out so good

Project

Listing date

Raised Listing price Price 1/16/19 Returns %

Medicalchain

2/6/18

$24,000,000.00

$0.32

$0.005

98.54%

AIdoc

1/10/18

N/A

$0.23

$0.004

98.29%

Patientory

6/6/17

$23,000,000.00

$0.65

$0.015

97.7%

Shivom

6/7/18

$35,000,000.00

$0.05

$0.001

97.2%

Curecoin

5/26/14

$6,800,000.00

$0.80

$0.05

93%

Medibloc

12/22/17

$6,000,000.00

$0.02

$0.00

89%

Medishares

12/13/17

N/A

$0.03

$0.01

76%

Nam

-coin

8/4/18

N/A

$0.0004

$0.0001

74%

Docademic

10/1/18

$1,100,000.00

$0.05

$0.01

72%

Lympo

3/1/18

$14,000,000.00

$0.02

$0.01

66%

Ambrosus

10/23/17

$32,000,000.00

$0.20

$0.08

62%

Farmatrust

8/14/18

$7,000,000.00

$0.01

$0.00

61%

Dentacoin

8/11/17

$3,000,000.00

$0.0003

$0.0001

52%

Modum

10/23/17

$13,400,000.00

$0.49

$0.30

38%

Timicoin

8/30/18

$20,000,000.00

$0.06

$0.05

23%

Encrypgen

11/20/17

$1,000,000.00

$0.05

$0.04

16%

At their peak the market capitalization for healthcare

tokens was briefly $3.5bn. It now rests around

$100m.

The next generation will be driven

by mechanism design

Game theory explores outcomes derived

from a set of rules.

Mechanism design is engineering the

rules to achieve a desired outcome.

Have pre-defined

rules?

Have a desired

outcome but no

rules?

Game

theory

Mechanism

design

Token economics

Using mechanism design within token

economies to achieve desired outcomes.

The tools we have at our disposal make this an

incredibly exciting field.

Staking Slashing Governing

Emerging token tools

Staking

Users receive a benefit for locking up their tokens

for a period of time

Example: users could lock up 100 tele-credits for a

month to get a 10% discount on a telemedicine

consultation.

Emerging token tools

Slashing

Users lock up their tokens for a period of time and

they are confiscated if they act dishonestly.

Example: users pay an “application fee” to be

verified as phyiscians on a decentralized registry. If

their applications are denied their application fee is

not returned.

Emerging token tools

Governing

Tokens grant the users the right to initiate and vote

on proposals that affect the network.

Example: A network of providers using the same

EHR could adopt changes in their data standard by

voting with tokens. Votes would be weighted by

how many tokens they have.

wave of tokens: decentralized

registry of physicians

• Uses token economics to incentivize actors to honestly

curate a list of verified physicians on chain.

• Primarily uses slashing as a way of keeping

applicants honest.

These are called Token Curated Registries (TCRs)

wave of tokens: healthcare

services as digital goods

Attributes

Redeemable for: 1 MRI

Issued by: community provider

Expires: 12/31/2019

Network: generic network

Transfers: restricted

Providers can issue digital goods which represent

discrete healthcare services. These can then be bought, sold,

and tracked on marketplaces.

Take aways

• The first wave of tokenization was in currencies, the

second wave will be digital goods in the form of NFTs

• Token economics is a real, emerging field but we are still

figuring out how to create sustainable value

• Enterprises should be focused on tokenization in the form

of digital goods

• Look for use cases where identity, scarcity, and value

are important

• The most valuable use cases will be those that involve

a network

Thank you!

bertcmiller

rmiller@honeycombhealth.com

bertcmiller

Blockchain & healthcare newsletter

www.bertcmiller.com/himss

Rishi Madhok, MD, Chief Executive Officer, BitMED

James A. Zadoorian, Ph.D. Managing Principal, ARxChange

For there to be a sustainable blockchain-based

economy of any sorts, there needs to be

sustainable economic activity

Inside the numbers

Inside the behavior

Inside the “game”

Inside the “moves”

Inside the payment decision

Inside the solution: intelligent price design

Future-state architecture?

Future-state stability

Questions?